Open AccessValidation of a Simplified Chinese Version of the Pain Catastrophizing Scale and an Exploration of the Factors Predicting Catastrophizing in Pain Clinic Patients
Author(s) -
Ximing Xu,
Xianzhao Wei,
Fei Wang,
Jie Liu,
Hui Chen,
Yang Xiong,
Ming Li
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2015/18/e1059
Subject(s) - pain catastrophizing , medicine , construct validity , confirmatory factor analysis , chronic pain , clinical psychology , exploratory factor analysis , content validity , observational study , rumination , physical therapy , psychometrics , psychiatry , structural equation modeling , cognition , statistics , mathematics , pathology
Background: Chronic pain is very common worldwide and can lead to disability, depressionand absence from work. Catastrophizing has been proven to affect individuals’ belief systems andcoping strategies, and it is an essential risk factor for chronic pain. The pain catastrophizing scale(PCS) has been developed for the assessment of catastrophizing. However, a Chinese version ofthis scale is not available, and physicians are therefore unable to determine which patients areprone to catastrophizing. Additionally, the risk factors for catastrophizing are unknown.Objective: We aimed to cross-culturally adapt and validate the PCS for simplified Chinese (SCPCS) and explore the risk factors for catastrophizing in patients from a pain clinic.Study Design: We utilized a prospective, nonrandomized, cross-sectional, descriptive surveydesign. A second analysis of test-retest reliability was performed in a longitudinal, observationalstudy.Setting: A convenience sample was recruited from a pain clinic in a tertiary hospital.Methods: This study was performed in 3 stages. In the first stage, the PCS was translated andculturally adapted to create a Chinese version; in the second stage, the measurement propertiesof the SC-PCS were tested, including the content validity, construct validity and reliability; andin the third stage, factors affecting catastrophizing in a pain clinic setting were explored. Theadaptation was performed using a forward-backward method, and content validity was analyzedby examining the response trend (Z-skewness and item-total correlation). Construct validity wasanalyzed by assessing structural validity (confirmatory factor analysis [CFA] and exploratory factoranalysis [EFA]) and a priori hypothesis testing. Reliability was analyzed by internal consistency(Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficient [ICC]). Risk factors forcatastrophizing were analyzed by multivariate linear regression.Results: A total of 153 patients were included, with a response rate of 96%; no items wereexcluded from the SC-PCS. Both CFA and EFA confirmed a 3-factor structure, and 9/10 of thehypotheses were verified for construct validity. Excellent reliability was acquired with a Cronbach’salpha of 0.91, and an ICC of 0.94 was determined. Risk factors for catastrophizing included collegeeducation (beta = 0.47), pain duration (beta = 0.40), female (beta = 0.31), freelancer status (beta= 0.31), and retired status (beta = 0.19).Limitations: The recruited patients experienced severe pain or long-duration pain in a pain clinicsetting. This may limit the applicability of the SC-PCS to patients with low or moderate pain levels.Conclusion: The PCS has been linguistically translated into simplified Chinese and culturallyadapted for a Chinese population with remarkable clinical acceptance, good construct validity, andexcellent internal consistency and test-retest reliability. Education, pain duration, marital status,gender, income, and use of pain medications are important factors affecting catastrophizing.Key words: Chronic pain, catastrophizing, HADS, SF-12, BPI, risk factor, reliability, validity